Failure to Follow Medication Administration Parameters for Resident with Bradycardia
Penalty
Summary
The facility failed to ensure that medications were administered within the physician-ordered parameters for a resident with multiple diagnoses, including acute and chronic respiratory failure, hypotension, dependence on a ventilator, and bradycardia. The resident had severely impaired cognition and was prescribed several antihypertensive medications, all with specific instructions to hold administration if the systolic blood pressure was less than 110 mmHg or if the heart rate was less than 60 beats per minute. Despite these clear parameters, the medical records and Medication Administration Records (MAR) showed that nursing staff repeatedly administered Amlodipine, Carvedilol, Clonidine, Doxazosin, and Hydralazine on multiple occasions when the resident's heart rate was below 60 bpm. Interviews with staff confirmed that they were aware of the medication parameters and the risks associated with administering these medications outside of those parameters. A CNA stated that staff are instructed to notify a nurse if a resident's pulse falls below 60 bpm, and an LPN confirmed that medication orders with parameters are to be followed as written. The LPN also reviewed the MAR and acknowledged that medications were given when the resident's pulse was below the required threshold, stating that they should have been held on those days. The Director of Nursing (DON) stated that the facility's expectation is for nursing staff to follow provider orders when administering medications and recognized that bradycardia can be dangerous. The DON also noted that episodes of bradycardia should be reported to the provider and that such events qualify as a change of condition. The facility's Medication Administration policy directs staff to review medication records and adhere to the five rights of medication administration, but this was not followed in the case of this resident.